Diverticulosis

Diverticula are small pouches that bulge outward through the colon, or large intestine. If you have these pouches, you have a condition called diverticulosis.

Diverticular disease affects the lining of your large intestine. It is caused by small pouches (called diverticula) that can form anywhere in your digestive tract, but usually form in the last part of the large intestine (called the colon).

The most common types of diverticular disease are:

  • Diverticulosis.

    People who have diverticulosis have pouches in the large intestine. Most people who have diverticulosis don't have any symptoms and may not even know they have it.

  • Diverticulitis.

    This occurs when the pouches become infected and inflamed. Symptoms of diverticulitis can include severe abdominal pain, fever, nausea, constipation or diarrhea. Less common symptoms include vomiting and frequent and painful urination. Pain is most often located on the lower left side of the abdomen. Complications of diverticulitis can include intestinal blockages and openings in the bowel wall.

  • Diverticular bleeding.

    Diverticular bleeding occurs when a blood vessel next to the pouches bursts. You may find blood in a bowel movement or in the toilet. If you notice blood coming from your rectum, you should call your doctor immediately.

Scientists are not exactly certain what causes diverticulosis and diverticular disease. Diverticulosis and diverticular disease were first noticed in the United States in the early 1900s, around the time processed foods were introduced into the American diet. Diverticulosis and diverticular disease are common in Western and industrialized countries—particularly the United States, England, and Australia—where low-fiber diets are common. The condition is rare in Asia and Africa, where most people eat high-fiber diets.

Studies have also found links between diverticular disease and obesity, lack of exercise, smoking, and certain medications including nonsteroidal anti-inflammatory drugs, such as aspirin, and steroids.

Scientists agree that with diverticulitis, inflammation may begin when bacteria or stool get caught in a diverticulum. In the colon, inflammation also may be caused by a decrease in healthy bacteria and an increase in disease-causing bacteria. This change in the bacteria may permit chronic inflammation to develop in the colon.

The most common symptom of this disease is pain in the lower left side of the abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and then worsen over several days. The intensity of the pain can fluctuate.

Symptoms of Diverticulitis may also cause

  • fevers and chills

  • nausea or vomiting

  • a change in bowel habits—constipation or diarrhea

  • diverticular bleeding

In most cases, people with diverticular bleeding suddenly have a large amount of red or maroon-colored blood in their stool.

Diverticular bleeding may also cause

  • weakness

  • dizziness or light-headedness

  • abdominal cramping

Based on symptoms and severity of illness, a person may be evaluated and diagnosed by a primary care physician, an emergency department physician, a surgeon, or a gastroenterologist—a doctor who specializes in digestive diseases.

  • Blood test.
     A blood test involves drawing a person’s blood at a health care provider’s office, a commercial facility, or a hospital and sending the sample to a lab for analysis. The blood test can show the presence of inflammation or anemia—a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen.
  • Computerized tomography (CT) scan.
    A CT scan of the colon is the most common test used to diagnose diverticular disease. CT scans use a combination of x rays and computer technology to create three-dimensional (3–D) images which can detect the appearance diverticula and confirm the diagnosis of diverticulitis.
  • Lower gastrointestinal (GI) series.
     A lower GI series is an x-ray exam that is used to look at the large intestine. The test is performed at a hospital or an outpatient center by an x-ray technician, and the images are interpreted by a radiologist. The health care provider may provide written bowel prep instructions to follow at home before the test to help flush out the patient’s large intestine.
  • Colonoscopy.
    The test is performed at a hospital or an outpatient center by a gastroenterologist. Before the test, the person’s health care provider will provide written bowel prep instructions to follow at home. In most cases, light anesthesia, and possibly pain medication, helps people relax for the test. The person will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The test can show diverticulosis and diverticular disease.

A health care provider may treat the symptoms of diverticulosis with a high-fiber diet or fiber supplements, medications, and possibly probiotics. Treatment for diverticular disease varies, depending on whether a person has diverticulitis or diverticular bleeding.